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      Vestibular Function and Quality of Life in Vestibular Schwannoma: Does Size Matter?


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          Objectives: Patients with vestibular schwannoma (VS) frequently suffer from disabling vestibular symptoms. This prospective follow-up study evaluates vestibular and auditory function and impairment of quality of life due to vertigo, dizziness, and imbalance in patients with unilateral VS of different sizes before/after microsurgical or radiosurgical treatment. Methods: Thirty-eight patients with unilateral VS were included. Twenty-two received microsurgery, 16 CyberKnife radiosurgery. Two follow-ups took place after a median of 50 and 186.5 days. Patients received a standardized neuro-ophthalmological examination, electronystagmography with bithermal caloric testing, and pure-tone audiometry. Quality of life was evaluated with the Dizziness Handicap Inventory (DHI). Patient data was grouped and analyzed according to the size of the VS (group 1: <20 mm vs group 2: ≥20 mm). Results: In group 1, the median loss of vestibular function was +10.5% as calculated by Jongkees Formula (range −43 to +52; group 2: median +36%, range −56 to +90). The median change of DHI scores was −9 in group 1 (range −68 to 30) and +2 in group 2 (−54;+20). Median loss of hearing was 4 dB (−42; 93) in group 1 and 12 dB in group 2 (5; 42). Conclusion: Loss of vestibular function in VS clearly correlates with tumor size. However, loss of vestibular function was not strictly associated with a long-term deterioration of quality of life. This may be due to central compensation of vestibular deficits in long-standing large tumors. Loss of hearing before treatment was significantly influenced by the age of the patient but not by tumor size. At follow-up 1 and 2, hearing was significantly influenced by the size of the VS and the manner of treatment.

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          Most cited references26

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          Stereotactic radiosurgery.

          L Leksell (1983)
          The development and scope of stereotactic radiosurgery is described. The technique, which combines well with the latest diagnostic methods, has already proved a safe and effective way of treating inaccessible cerebral lesions and in particular small arteriovenous malformations, acoustic neuroma and the solid component of craniopharyngioma, as well as playing an increasingly useful role in the therapy of pituitary adenoma.
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            The Cyberknife: a frameless robotic system for radiosurgery.

            The Cyberknife is a unique instrument for performing frameless stereotactic radiosurgery. Rather than using rigid immobilization, the Cyberknife relies on an image-to-image correlation algorithm for target localization. Furthermore, the system utilizes a novel, light-weight, high-energy radiation source. The authors describe the technical specifications of the Cyberknife and summarize the initial clinical experience.
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              Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery.

              The best management for patients with small- to medium-sized vestibular schwannomas (VS) is controversial. : A prospective cohort study of 82 patients with unilateral, unoperated VS less than 3 cm undergoing surgical resection (n = 36) or radiosurgery (n = 46). Patients undergoing resection were younger (48.2 yr versus 53.9 yr, P = 0.03). The groups were similar with regard to hearing loss, associated symptoms, and tumor size. The mean follow-up period was 42 months (range, 12-62 mo). Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at 3 months (P < 0.001), 1 year (P < 0.001), and at the last follow-up examination (P < 0.01) compared with the surgical resection group. Patients undergoing surgical resection had a significant decline in the following subscales of the Health Status Questionnaire 3 months after surgery: physical functioning (P = 0.006), role-physical (P < 0.001), energy/fatigue (P = 0.02), and overall physical component (P = 0.004). Patients in the surgical resection group continued to have a significant decline in the physical functioning (P = 0.04) and bodily pain (P = 0.04) subscales at 1 year and in bodily pain (P = 0.02) at the last follow-up examination. The radiosurgical group had no decline on any component of the Health Status Questionnaire after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at the last follow-up examination. There was no difference in tumor control (100 versus 96%, P = 0.50). Early outcomes were better for VS patients undergoing stereotactic radiosurgery compared with surgical resection (Level 2 evidence). Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.

                Author and article information

                Front Neurol
                Front. Neur.
                Frontiers in Neurology
                Frontiers Research Foundation
                26 July 2011
                30 August 2011
                : 2
                : 55
                [1] 1simpleDepartment of Neurology, Ludwig-Maximilians University Munich, Germany
                [2] 2simpleEuropean CyberKnife Center Munich, Germany
                [3] 3simpleDepartment of Neurosurgery, University of Cologne Cologne, Germany
                [4] 4simpleDepartment of Neuroradiology, Kiel University Kiel, Germany
                [5] 5simpleDepartment of Neurosurgery, Ludwig-Maximilians University Munich, Germany
                Author notes

                Edited by: Herman Kingma, Maastricht University, Netherlands

                Reviewed by: Aasef G. Shaikh, Case Western Reserve University, USA; Sergei B. Yakushin, Mount Sinai School of Medicine, USA

                *Correspondence: Judith Nastjenka Wagner, Department of Neurology, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistraße 15, D-81366 Munich, Germany. e-mail: judith.wagner@ 123456med.uni- muenchen.de

                This article was submitted to Frontiers in Neuro-otology, a specialty of Frontiers in Neurology.

                Copyright © 2011 Wagner, Glaser, Wowra, Muacevic, Goldbrunner, Cnyrim, Tonn and Strupp.

                This is an open-access article subject to a non-exclusive license between the authors and Frontiers Media SA, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and other Frontiers conditions are complied with.

                : 29 June 2011
                : 09 August 2011
                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 27, Pages: 7, Words: 5042
                Original Research

                cyberknife,vestibular schwannoma,vertigo,microsurgery
                cyberknife, vestibular schwannoma, vertigo, microsurgery


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